Laser tonsillotomy with local anesthesia linked with improved recovery, finds JAMA study
Netherlands: Results from a trial showed that laser tonsillotomy performed under local anesthesia versus tonsillectomy performed under general anesthesia is associated with a significantly shorter and less painful recovery period. The study was published in JAMA Network Open on February 21, 2022.
Tonsillitis, tonsillolithiasis, peritonsillar abscess, dysphagia, halitosis, and snoring are common conditions related to tonsils in adults. Surgery is indicated in cases when conservative treatment of these condition fails. Previous studies have shown carbon dioxide laser tonsillotomy performed under local anesthesia to be an effective and less invasive alternative to dissection tonsillectomy for treatment of tonsil-related afflictions.
Against the above background, Justin E. R. E. Wong Chung, Department of Otolaryngology Head and Neck Surgery, Hagaziekenhuis, The Hague, the Netherlands, and colleagues aimed to compare functional recovery and symptom relief among adults undergoing tonsillectomy or tonsillotomy in a randomized clinical trial.
The trial was conducted across 5 secondary and tertiary hospitals in the Netherlands from January 2018 to December 2019. It included 199 adult patients with an indication for surgical tonsil removal. They were randomly assigned to either tonsillectomy (n=101) or tonsillotomy group (n=98).
In tonsillotomy, the crypts of the palatine tonsil were evaporated using a carbon dioxide laser under local anesthesia. Tonsillectomy consisted of total tonsil removal performed under general anesthesia.
Time to functional recovery measured within 2 weeks after surgery assessed for a modified intention-to-treat population was the primary outcome.
Following were the study's key findings:
- Recovery within 2 weeks after surgery was significantly shorter after tonsillotomy than after tonsillectomy (hazard ratio for recovery after tonsillectomy vs tonsillotomy, 0.3; 95% CI, 0.2-0.5).
- Two weeks after surgery, 72 (77%) patients in the tonsillotomy group were fully recovered compared with 26 (57%) patients in the tonsillectomy group.
- Time until return to work within 2 weeks was also shorter after tonsillotomy (median, 4.5 days' vs 12.0 days; hazard ratio for return after tonsillectomy vs tonsillotomy, 0.3).
- Postoperative hemorrhage occurred in 2 patients (2%) in the tonsillotomy group and 8 patients (12%) in the tonsillectomy group.
- At 6 months after surgery, fewer patients in the tonsillectomy group (25; 35%) than in the tonsillotomy group (54; 57%) experienced persistent symptoms (difference of 22%).
- Most patients with persistent symptoms in both the tonsillotomy (32 of 54; 59%) and tonsillectomy (16 of 25; 64%) groups reported mild symptoms 6 months after surgery.
The authors conclude, "laser tonsillotomy performed under local anesthesia may be a feasible alternative to conventional tonsillectomy in this population."
Reference:
Wong Chung JERE, van Geet R, van Helmond N, et al. Time to Functional Recovery After Laser Tonsillotomy Performed Under Local Anesthesia vs Conventional Tonsillectomy With General Anesthesia Among Adults: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(2):e2148655. doi:10.1001/jamanetworkopen.2021.48655
